A 42-year-old woman with regular cycles presents with heavy menstrual bleeding for 8 months. Pelvic ultrasound shows a normal uterus and ovaries, endometrial thickness of 6 mm. Hemoglobin is 9.8 g/dL. According to the PALM-COEIN classification, if no structural lesion is found and she has regular ovulatory cycles, which category best describes the likely etiology?
- A AUB-O (ovulatory dysfunction)
- B AUB-E (endometrial) ✓
- C AUB-L (leiomyoma, submucosal)
- D AUB-A (adenomyosis)
Correct answer: B. AUB-E (endometrial)
Explanation
In ovulatory heavy menstrual bleeding with no structural abnormality identified, the disorder lies at the endometrial level (AUB-E), involving local hemostatic dysfunction such as abnormal prostaglandin balance or fibrinolysis. AUB-O applies to anovulatory bleeding. AUB-L and AUB-A are structural causes and would be visible on imaging or confirmed histologically.
Reference: Berek and Novak's Gynecology, 16th ed.
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Written and medically reviewed by the StethoPrep medical team.